Thousands of babies are born each year with dual or anomalous sexual characteristics. The standard practice for attending physicians has been to try to “fix” the problem. Alice Dreger argues that this generally does more harm than good and often results in permanent damage or diminished function:

“Human sex comes in two big themes — male and female — but nature seems to enjoy composing variations on those themes. Some sex variations occur at the level of sex chromosomes, some at the level of hormones, some at the level of hard-to-detect internal structures, and some at the level of anatomical parts you can see with the naked eye (assuming your eye isn’t the only thing that’s naked). If you call all of these variations intersex, you can then ask how common intersex is. That’s a question people love to ask. The problem is that to answer that question, one has to first decide how subtle a variation to count. How small should a penis be to count as intersex rather than male? How big a clitoris should count? How subtle a difference in hormone receptors? The truth is that human sex isn’t simple. Human sex is practically fractal.

“Nevertheless, wherever nature draws unclear boundaries, humans are happy to curate. And the specialist curators of sex tell us this: In America today, about one in two thousand babies is born with genitals so notably intersex that a specialist team is immediately called in. About one in three hundred babies has genitals unusual enough that the average pediatrician will give the parents a referral to a specialist. If you add up all of the dozens of kinds of sex anomalies — including incredibly subtle things you might never know you had without the benefit of a lot of fancy medical scans your insurance company probably doesn’t want to cover — the frequency of intersex in the human population comes to about one in a hundred. …

“[Starting] in the 1910s — biopsies [became] possible, and … suddenly doctors could conclusively diagnose working ovaries in men, working testes in women, and ovotestes in both — not a happy thing unless you’re a gender radical. So again doctors did what they had to do to preserve the two-sex social order. Although they still categorized a patient’s ‘true sex’ according to gonadal tissue, in practice they classified patients according to which gender was most believable. If an attractive housewife happened to have testicles, no one besides her doctor needed to know her diagnosis of male pseudohermaphroditsm. If a man really was menstruating, you just quietly took his ovaries out and hoped no one found out about his insides. Doctors continued to clean up nature’s little indiscretions and thus take care not only of individual bodies, but also the social body.

“Given the way intersex could always threaten a sexist two-gender society, this approach of ‘cleaning up’ nature’s sexual ‘mistakes’ persisted in American medicine. … Modern medicine now sought to reinforce the ‘optimum gender of rearing’ by early management of children born with sex anomalies by means of ‘sex-normalizing’ surgeries, hormone treatments, delicate euphemisms, and sometimes lies. …

“This was … the system that led to a lot of really angry intersex adults who discovered that they had been harmed by the medical care meant to ‘save’ them and who knew the same basic system was still being used on children who would likely grow up as hurt and angry as they were. In the early 1990s, a core group of these people formed [an] intersex rights movement. … Some of these intersex adults had been physically harmed — left with damaged sexual sensation, incontinence, or repetitive infections. Many had been psychologically harmed — left with a sense of having been too monstrous for their parents to accept as they came, of being sexually freakish, of being fountains of familial shame. All were left with a burning desire to try to save others from going through what they had. …

As late as 1995, medical students were being taught the following in the latest medical books, If a baby is born with a large clitoris, she might turn out to be a lesbian, so you have to cut down her clitoris. If a boy is born with hypospadias — wherein the opening of his urethra is not at the tip of the penis but on the underside or down near the scrotum — he will not be able to write his name in the snow next to other little boys, and then he might turn out gay. Therefore you have to do a ‘corrective’ surgery to make sure he can pee standing up. Mind you, this surgery failed so often that doctors had a special term for the men in whom it failed. They were called hypospadias cripples, because life is tough with a surgically scarred, infection-prone penis, but, the urologists insisted, you had to try to get that boy to pee standing up. Or else.”

“Does what goes on inside show on the outside?,” young Vincent van Gogh despaired in a moving letter to his brother while floundering to find his purpose. “Someone has a great fire in his soul and nobody ever comes to warm themselves at it, and passers-by see nothing but a little smoke at the top of the chimney.” A century later, Joseph Campbell stoked that hearth of the soul with his foundational treatise on finding your bliss. And yet every day, countless hearths and hearts grow ashen in cubicles around the world as we succumb to the all too human tendency toward choosing what we should be doing in order to make a living over what we must do in order to feel alive.

How to turn that invisible inner fire into fuel for soul-warming bliss is what artist and designer Elle Luna explores in her essay-turned-book The Crossroads of Should and Must: Find and Follow Your Passion – an intelligent and rousing illustrated manifesto that picks up where Campbell left off.

Distinguishing between a job (“something typically done from 9 to 5 for pay”), a career (“a system of advancements and promotions over time where rewards are used to optimize behavior”), and a calling (“something that we feel compelled to do regardless of fame or fortune”), Luna recounts the pivotal moment in her own life when she was suddenly unable to discern which of these she had. As an early employee at a promising startup, she was working tirelessly on a product she deeply believed in, and yet felt disorientingly unfulfilled. She found herself before a revelatory crossroads: the crossroads between Should and Must.

Luna writes:

Should is how other people want us to live our lives. It’s all of the expectations that others layer upon us.

Sometimes, Shoulds are small, seemingly innocuous, and easily accommodated. “You should listen to that song,” for example. At other times, Shoulds are highly influential systems of thought that pressure and, at their most destructive, coerce us to live our lives differently.

Echoing Eleanor Roosevelt’s famous admonition – “When you adopt the standards and the values of someone else … you surrender your own integrity,” the longest-serving First Lady wrote in contemplating conformity and the secret of happiness, “[and] become, to the extent of your surrender, less of a human being.” – Luna adds:

When we choose Should, we’re choosing to live our life for someone or something other than ourselves. The journey to Should can be smooth, the rewards can seem clear, and the options are often plentiful.

She offers a counterpoint:

Must is different. Must is who we are, what we believe, and what we do when we are alone with our truest, most authentic self. It’s that which calls to us most deeply. It’s our convictions, our passions, our deepest held urges and desires – unavoidable, undeniable, and inexplicable. Unlike Should, Must doesn’t accept compromises.

Must is when we stop conforming to other people’s ideals and start connecting to our own – and this allows us to cultivate our full potential as individuals. To choose Must is to say yes to hard work and constant effort, to say yes to a journey without a road map or guarantees, and in so doing, to say yes to what Joseph Campbell called “the experience of being alive, so that our life experiences on the purely physical plane will have resonance within our innermost being and reality, so that we actually feel the rapture of being alive.”

Choosing Must is the greatest thing we can do with our lives.

And yet as simple as Luna’s elegant prose makes it sound, anyone who has lived through this crossroads – she has; I have – will attest that it is anything but easy; the road is strewn with difficult choices. Luna considers the osmotic relationship between Should and Must, even as we turn away from one and toward the other:

If you want to know Must, get to know Should. This is hard work. Really hard work. We unconsciously imprison ourselves to avoid our most primal fears. We choose Should because choosing Must is terrifying, incomprehensible. Our prison is constructed from a lifetime of Shoulds, the world of choices we’ve unwittingly agreed to, the walls that alienate us from our truest, most authentic selves. Should is the doorkeeper to Must. And just as you create your prison, you can set yourself free.

One of the most common ways in which we imprison ourselves is by comparing ourselves to others and, upon finding our situation inferior, placing blame – on circumstances that we feel are unfair, on the people we believe are responsible for those circumstances, or on some abstract element of fate we think is at play. The self-defeating catch is that we often end up judging our circumstances against others’ outcomes, forgetting that hard work and hard choices are the transmuting agent between circumstance and outcome.

Joseph Brodsky captured this with piercing precision in the greatest commencement address of all time, cautioning: “A pointed finger is a victim’s logo… No matter how abominable your condition may be, try not to blame anything or anybody: history, the state, superiors, race, parents, the phase of the moon, childhood, toilet training, etc. The menu is vast and tedious, and this vastness and tedium alone should be offensive enough to set one’s intelligence against choosing from it. The moment that you place blame somewhere, you undermine your resolve to change anything.”

Luna touches on this perilous tendency as she considers the origin of Should:

How often do we place blame on the person, job, or situation when the real problem, the real pain, is within us? And we leave and walk away, angry, frustrated, and sad, unconsciously carrying the same Shoulds into a new context – the next relationship, the next job, the next friendship – hoping for different results.

Must is fantastic, and Must is just on the other side of Should. Should is this world of expectations – it’s like a camouflaged force. That’s one of the tricky things about Should – it can kind of creep in there when you’re not looking. It’s easier – it’s this invisible force moving against us [and] it often comes very early on in life. It can come from the time into which we’re born, the society or the community into which we’re born, the body into which we’re born… It can be a lot of different things that happen early in life [which] really take on that trajectory … and have us often running a different race than the one we were intended to run.

I’ve been plagued by ghosts recently. A haunting of sorts.
Not hole in the sheet ghosts, but ghosts made of memory.
As I lie in bed, in the wee hours, they travel through my mind, dragging nets filled with disembodied faces after them.
I’m curious as to why they have decided to force a ‘re-membering’ at this time.
Why would an unconscious, biorhythmic timekeeper conspire to flood my thought stream with thick glistening chunks of butchered memory?
They lie around in a seemingly, chaotic, unrelated piles, begging to be deciphered like the dusty bones thrown from an ancient sangoma’s hand.
Im being invited to open to them during this time of gentle retreat in the Karoo. As I stare at the dancing flames, feelings beckon me towards them, no longer afraid, I turn and follow them into the night.